Typical operating room procedures followed in hospitals and other surgical areas establish rigid rules regarding sterile and non-sterile working areas, instruments, absorbent articles, and the like for use during an operation. These rules, coupled with other hospital procedures, provide a measure of assurance that only sterilized items or personnel may be used with or contact the patient during surgery. Typical operating rooms have sterile fields which include an operating table, supplies-and-instruments holding tables, and portions of various operating room personnel. Typically, the sterile supplies and instruments are placed in the operating room by a non-sterile person. The non-sterile person must place the supplies and instruments on the sterile field without touching or otherwise contaminating the sterilized items or the sterile field. Generally this involves handling the exterior surfaces of sterilized wrapping sheets or containers and tossing the contents through the air from a short distance away onto the sterile field.
Among the supplies typically used during a surgery are absorbent sponges, pads or the like. These generally are gauze or fabric-like woven materials made from cellulose and other materials which are subject to sterilization. A quantity of these absorbent materials are sealed in discardable containers and sterilized. Prior to use, the cover of the sterilized container may then be removed and the contents directed to the sterile field. There are a variety of known sterilizing techniques useful in preparing supplies and instruments for surgery, including exposure to ethylene oxide, steam, or radiation.
One known dispenser for absorbent surgical articles, such as bound laparotomy sponges, is the Kendall peel-tub sterilization container. This vacuum molded container may be inexpensively manufactured using a variety of plastics. A known number of sponges are rolled up, bundled together, and placed in the Kendall tub, and the tub and its contents are sterilized by a known approved technique prior to use of the contained sponges in an operation. Following the sterilization process, hospital rules consider the contents sterile and free from contamination while the tub exterior is considered non-sterile. That does not mean the exterior is contaminated; it means that there is no assurance that the exterior is free of contamination and thus the tub cannot be placed within the sterile field. Consequently, it is permissible for the exterior surface of the Kendall tub to be handled by a non-sterile technician setting up the operating room. The technician opens the container by peeling a cover away from the container and with a shaking motion, tosses the contents of the tub onto the sterile field. Sometimes the sponges or other contents of a sterilized container bounce off the sterile field onto the floor or other non-sterile area, which means these sponges or items cannot be used and thus are wasted.
The sterile pads placed on the sterile field are accounted and used by the medical personnel during the operation. After the operation, all absorbent articles (and instruments as well) must be accounted by physically counting each sponge used during the operation. The number of used sponges plus the number of sponges remaining available for use must equal the total number of sponges available prior to the operation. A known present practice to account the use of these absorbent articles requires manually counting the sponges when each sterilized container is opened by the technician and the sponges are placed on the sterile field. The count is repeated at the closing of each layer of the surgical area in the patient. Because the closing cannot proceed until each pad is accounted, tracking used pads is critical.
Although other techniques have been used previously, these have drawbacks or difficulties when used. One such method uses sponges with long attached tags. The tags remain outside the incision and aid in both counting and retrieval of the sponge. Such products however are little used because of the clutter introduced into the operative field by the many streamers coming from the patient's incision. Another known counting system includes a ring where sponges in the body are attached to the ring. When the ring is removed from the body area all sponges must be out of the body. Another known system attaches spent sponges to a rack with a fastener. Still another system employs a sheet having pouches which hold used sponges. These methods and structures to account for the number of absorbent articles removed from a dispenser have drawbacks. For instance, a pouch capable of holding five used sponges may by mistake hold fewer or more sponges than it was intended to hold. The contents of each pouch must be recounted until the total number of sponges is accounted. Also ribbons connected to the sponge clutter the incision area on the patient. Sponges interconnected on a common thread or wire may not be conveniently usable--moving a new sponge may dislodge another sponge already in place.
U.S. Pat. No. 1,932,753 issued to Rueger describes a package having a flexible strip which encircles or embraces individual cigarettes in a package. The strip is numbered adjacent its connection to each cigarette. Upon removal of a cigarette from the container, the number on the strip acts as a flag to indicate the number of cigarettes remaining in the container. The leading edge of the strip is severed from the strip and discarded as the cigarettes are removed from the pack.
U.S. Pat. No. 2,793,745 issued to Cox describes a package dispenser having a dome-shaped housing fastened to a backing panel. The housing may be scored or perforated to define an opening through which the contents of the package may be dispensed.
U.S. Pat. No. 3,338,400 issued to Edgworth et al. describes packing devices for articles requiring sterile and/or aseptic conditions. A flange dish includes a body portion with side walls and end walls for holding an article to be sterilized. A sheet member is bonded over the dish to establish a complete peripheral seal. Edgworth further describes including tear notches in the sheet member to facilitate rapid and convenient opening of the sealed package. Holding areas on the dish permit gripping the dish while avoiding contamination of the sterilized contents. Edgworth also suggests that the flange of the dish may extend axially to define an area for carrying legends or other identifiers or for including a perforated portion of the covering sheet to facilitate opening the package.
U.S. Pat. No. 3,481,462 issued to Chapel describes a disposable surgical article holder and counter. The holder provides an elongated base having a plurality of holes or openings in the upper surface. The base may be sealed with a removable cover. The surgical articles are replaced in the base openings after use, and a visual count can be made by determining whether any of the openings are unoccupied.